8.30 FALSELY MAKING, ALTERING, FORGING OR COUNTERFEITING A WRITING TO OBTAIN MONEY FROM UNITED STATES (18 U.S.C. § 495)
The defendant is charged in [Count _______ of] the indictment with falsely making, altering, forging, or counterfeiting [specify writing] in violation of Section 495 of Title 18 of the United States Code. In order for the defendant to be found guilty of that charge, the government must prove each of the following elements beyond a reasonable doubt:
First, the defendant [falsely made] [altered] [forged] [counterfeited] [specify writing]; and
Second, the defendant did so for the purpose [of obtaining or receiving] [enabling another person to obtain or receive] money from [the United States] [an officer of the United States] [an agent of the United States].